Scaffold For Spring Ligament Repair

ABSTRACT

A construct is disclosed that may be used to repair or replace a natural ligament. The construct may be formed of materials for biocompatibility and/or resorbtion. The construct may be provided or connected to a soft anchor for connection to a bone portion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No. 61/783,976, filed on Mar. 14, 2013.

This application is a continuation-in-part of U.S. patent application Ser. No. 14/055,191 filed on Oct. 16, 2013, which is a divisional of U.S. patent application Ser. No. 13/098,897 filed on May 2, 2011, now U.S. Pat. No. 8,562,645 issued on Oct. 22, 2013, which is a continuation-in-part of U.S. patent application Ser. No. 12/702,067 filed on Feb. 8, 2010, which is a continuation of U.S. patent application Ser. No. 11/541,505 filed on Sep. 29, 2006 and is now U.S. Pat. No. 7,658,751 issued on Feb. 9, 2010.

This application is a continuation-in-part of U.S. patent application Ser. No. 12/719,337 filed on Mar. 8, 2010, which is a continuation-in-part of U.S. patent application Ser. No. 12/489,168 filed on Jun. 22, 2009, now U.S. Pat. No. 8,361,113 issued on Jan. 29, 2013, which is a continuation-in-part of U.S. patent application Ser. No. 12/474,802 filed on May 29, 2009, now U.S. Pat. No. 8,088,130 issued on Jan. 3, 2012, which is a continuation-in-part of (a) U.S. patent application Ser. No. 12/196,405 filed on Aug. 22, 2008, now U.S. Pat. No. 8,128,658 issued on Mar. 6, 2012; (b) U.S. patent application Ser. No. 12/196,407 filed on Aug. 22, 2008, now U.S. Pat. No. 8,137,382 issued on Mar. 20, 2012; (c) U.S. patent application Ser. No. 12/196,410 filed on Aug. 22, 2008, now U.S. Pat. No. 8,118,836 issued on Feb. 21, 2012; and (d) U.S. patent application Ser. No. 11/541,506 filed on Sep. 29, 2006, now U.S. Pat. No. 7,601,165 issued on Oct. 13, 2009.

The entire disclosure of the above applications are incorporated herein by reference.

FIELD

The subject disclosure is generally directed towards ligament repair and/or augmentation, and particularly to an augment construct that is configured to replace or augment a spring ligament in a foot.

BACKGROUND

This section provides background information related to the present disclosure which is not necessarily prior art.

A spring ligament is an anatomical ligament that interconnects various portions of a foot. Generally, the spring ligament may interconnect at least a navicular and a calcaneus. Various branches of the spring ligament, however, may also extend to connect or interconnect the calcaneus with the first cuneiform.

Injury to the spring ligament may lead to various issues, such as flat-foot deformities. Injuries to the spring ligament may not generally be diagnosed or repaired until various auxiliary issues present themselves, such as flat-foot deformities. Repairing a defect in the spring ligament, therefore, may lead to prevention of various afflictions.

SUMMARY

This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.

A ligament construct may be manufactured to repair or replace a selected ligament. For example, a spring ligament replacement or augment may include a synthetic scaffold that may be formed or manufactured to generally replace the spring ligament. The synthetic scaffold may be formed of polyester, polyethylene, resorbable materials, or combinations thereof. The synthetic scaffold may be formed of a woven or braided polyester or polyethylene material that is formed into selected configuration or shape to replace the spring ligament.

Selected suture anchoring systems and tensioning systems may be used to fixedly connect the ligament augment to the anatomy. For example, a Juggerknot™ soft anchor or suture anchor may be used to provide an anchor adjacent to or inside of a bone member. Alternatively, a ToggleLoc™ hard suture anchor may be used. A suture tensioning system, such as the Ziploop™ suture tensioning system may be used to draw the scaffold into the bone, and tension the augment relative to the bone while the Juggerknot™ anchor system is used to anchor the construct. It is understood, however, that the tensioning system may be used in combination with any appropriate anchor, such as an interference screw or other bone anchor system.

The scaffold may be used to replace the spring ligament. For example, a user may identify a spring ligament tear or removal from a bone portion and identify a need for an augment or ligament replacement. The spring ligament construct may then be fixed relative to the bone, such as with an appropriate anchor and tensioning system. The anchors may include the Juggerknot™ soft anchor system. The construct may then be maintained relative to the bone for a procedure and/or fixed to the remaining portion of the spring ligament to assist in augmenting the remaining spring ligament portions.

Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure.

FIG. 1A is a top plan view of a ligament construct connected to suture, according to various embodiments;

FIG. 1B is a side plan view of the ligament construct of FIG. 1A connected to suture;

FIG. 2A is a top plan view of a ligament construct according to various embodiments;

FIG. 2B is a side plan view of the ligament construct of FIG. 2A connected to suture;

FIG. 3 is a top plan view of a ligament construct according to various embodiments;

FIG. 4 is a detail view of a portion of a ligament construct connected to a suture and an anchor, according to various embodiments;

FIG. 5 is a side plan view of bones of a human foot illustrating a partial implantation of a ligament construct in a navicular bone;

FIG. 6 is a side plan view of bones of a human foot illustrating a partial implantation of a ligament construct in a navicular bone and calcaneus bone;

FIG. 7A is a side plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a navicular bone and calcaneus bone;

FIG. 7B is a bottom plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a navicular bone and calcaneus bone;

FIG. 8 is a side plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a cuneiform, a navicular bone, and a calcaneus bone, according to various embodiments;

FIG. 9 is a top plan view of a ligament construct connected to a suture, according to various embodiments; and

FIG. 10 is a side plan view of bones of a human foot illustrating an implantation and tensioning of a ligament construct in a navicular bone, talus bone, and calcaneus bone, according to various embodiments.

Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference to the accompanying drawings.

With reference to FIGS. 1A and 1B, a ligament augment or replacement construct 20 is illustrated. The ligament construct 20 may be formed of selected materials, such as a woven or braided polyester or polyethylene material. Additionally, various absorbable materials may be included or used to form the construct 20, such as polylactic acid or other selected materials. The construct 20 may be formed of a woven material and/or formed of a solid material of a selected type. The construct 20, according to various embodiments, may be resilient with little to no elasticity. Thus, the length of the construct 20 may be selected and maintained during implantation. Also, the construct 20, therefore, may be tensioned and maintain a tension after implantation.

The construct 20 may include a selected length 22 that extends between a first end 24 and a second end 26. The two ends 24, 26 may be formed by folding terminal end regions 28 and 30 over and towards a center of the construct 20. The terminal ends 28, 30 may be folded onto a body portion 36 of the construct 20. The terminal ends 28, 30 may be stitched, sonically welded, or otherwise fixed with a mechanism 32, 34 to the main body portion 36 of the construct. The folding over of the terminal ends 28, 30 may form passages, also referred to as eyelets, a loop, or open regions 40 and 42 near the ends 24, 26 of the construct 20. The passages, as discussed herein, may be engaged or coupled to sutures and/or anchor members.

The main body portion, or selected portions of the construct 20, may have a thickness 44 based upon various characteristics of the construct 20, such as strength, rigidity, elasticity, and the like. Moreover, it is understood that if the construct 20 is formed of a braided, woven, or other appropriate material that the thickness 44 may decrease under a load between the two eyelet portions 40, 42. The thickness 44, however, may be defined by one or more strands of a woven material

According to various embodiments, the eyelets 40, 42 may be formed around suture and one or more suture constructs including a first suture construct 50 and a second suture construct 52; and/or the suture constructs 50, 52 may be formed within the eyelets 40, 42 and around the construct 20. The suture constructs 50 and 52 may be separate, but substantially identical and interconnected with the separate eyelets 40, 42 for fixation of the construct 20 relative to a selected anatomy, as discussed further herein. The suture constructs 50, 52 may be similar to the suture constructs disclosed in U.S. Pat. No. 8,118,836, issued Feb. 21, 2012; U.S. Pat. App. Pub. No. 2011/0098727, published on Apr. 28, 2011; or U.S. Pat. App. Pub. No. 2012/0095470, published on Apr. 19, 2012; all incorporated herein by reference.

Generally, the suture constructs may include respective anchors that may be formed as tubes 54, 56 through which a suture or selected filament 58, 60 passes. The suture 58, 60, when acted upon by a user, may cause the tubes 54, 56 to form an anchoring mass as knots or soft anchors to hold the construct 20 in a selected position. The anchoring mass can be formed on an exterior surface of a bone or formed within a bone surface, as discussed further herein. The suture anchors may include the Ziploop™ constructs to allow for slip tensioning of a portion positioned relative to the Ziploop suture construct and a Juggerknot™ anchor portion that may be formed by the respective tubes 54, 56. Each of the Ziploop™ suture construct and the Juggerknot™ soft anchor portion are sold by Biomet, Inc.

The sutures 58, 60 may further pass through a body or passage portion 70, 72 where two suture ends of each suture construct 50, 52 extend from the respective passage portions 70, 72. Each of the sutures 50, 52 has the respective passage portion 70, 72 and each defines a respective through-passage through the passage portions 70, 72. Each suture construct 50, 52 further has two ends 76, 78 and 80, 82. For each suture construct the first end 76, 80 is passed into the through-passage through a first aperture to form a first loop and exits the through-passage through a second aperture and the second end 78, 82 is passed into the through-passage through a third aperture to form a second loop and exits the through-passage through a fourth aperture. It is understood, according to various embodiments, the first and third aperture may be the same aperture as may the second and fourth aperture. Thus, each passage portion may include 2, 3, or 4, or a selected number of apertures into the through-passage of the passage portion. Each of the two suture ends 76, 78 and 80, 82 may be acted upon by a user to collapse the respective anchors 50, 56 to form the soft anchoring masses and tension the construct 20 between two points of the anchors 54 and 56, as discussed further herein.

The anchor assemblies 50, 52 including the anchors 54, 56, also referred to as tubes, which may generally include a collapsible tube that is a closed loop of suture material that is formed into the tube shape. According to various embodiments, the tube assembly 54, 56 may be slideable relative to the suture loops or filaments 58, 60. Briefly, although disclosed in the U.S. Pat. No. 8,118,836, incorporated herein by reference, the suture assemblies 50, 52 may include the suture portions 58, 60 that pass through openings 55, 57 of the respective tubes 54, 56. Alternatively, the suture portions may pass out an aperture that is not at the openings 55, 57 such that one or both ends of the tubes 54, 56 form flaccid or unbound ends.

Generally, the suture portions 58, 60 may be single or continuous suture filaments that extend through the respective tubes, 50, 56 in the respective braided bodies 70, 72 of the suture assemblies 50, 52. The suture assemblies 50, 52, therefore, may be manipulated by a user to generate a soft anchor, as discussed herein, by collapsing the respective tubes 50, 56, and tensioning the construct 20 relative to selected areas of a subject by moving the ends 76-82 to tension the construct 20 relative to the respective anchors formed by the tubes 54, 56. The anchors 54, 56 collapse under a force, such as a tensile force, provided by or through the respective suture portions 58, 60 to form soft or anchor masses in respective areas, as discussed further herein. The tubes 54, 56 may form the anchors by collapsing the tubes 54, 56 relative to a positive or adjacent surface of the tube 54, 56.

With reference to FIGS. 2A and 2B, a construct 100 is illustrated. The construct 100 may be similar to the construct 20 in general construction. For example, the construct 100 may be formed of a woven selected material, such as polyester or polyethylene. Additionally, the construct 100 may be formed from a selected material including bio-absorbable materials that may be absorbed into a selected anatomy over time and allow for ingrowth of various tissues to replace portions of the construct 100.

The construct 100, however, may also be formed in a substantially elongated and rectangular construct including a length 102 from a first end 100 a to a second end 100 b of about 4 centimeters (cm) to about 10 cm, and further including 4 cm to about 8 cm. Additionally, the construct 100 may include a width 104 that is about 0.5 cm to about 4 cm, including about 1-3 cm, and further including about 1 cm to about 2 cm. The construct 100, as illustrated in FIG. 2B, may further include a thickness 106 that is about 0.5 millimeters (mm) to about 4 mm, and further including about 1 mm to about 3 mm.

The construct 100 may include one or more bores 110 formed from a first side to a second side through the thickness 106 of the construct 100. The bores 110 may be formed in a selected configuration, such as near a perimeter of the construct 100. The bores 110 are generally formed at or near both of the ends 100 a, 100 b of the construct 100. Thus, the ends 100 a, 100 b of the construct 100 can be engaged and tensioned relative to selected anchoring regions, as discussed herein. The bores 110 may allow for passage of selected anchor assemblies, such as an anchor assembly 120, as discussed further herein. Any appropriate anchoring assembly, such as the construct 50, however, may also be used.

The anchor assembly 120 may pass through one or more of the throughbores 110 to allow for fixation of the construct 100 relative to a selected subject. The bores 110 may be throughbores formed through the construct 100 through various techniques such as puncturing, drilling, ultrasonic welding or puncturing, or other appropriate mechanisms. Also, the through bores 110 may be formed between braided or woven fibers of the construct 100. Regardless, the bores 110 may be throughbores formed through the entire thickness 106 of a construct 100 to allow for passage of anchor assemblies 120.

The anchor assembly 120 may be an anchor assembly including an anchor assembly as disclosed in U.S. Pat. No. 8,118,836, incorporated herein by reference. The anchor assembly 120 may include various portions similar to the anchor assemblies 50, 52 described above. Generally, the anchor assembly 120 may include a first collapsible anchor 122 (also referred to as a tube) and a second collapsible anchor 124 (also referred to as a tube) which are disposed about or around respective suture loops 126 and 128 that are a part of a single elongated suture of the anchor assembly 120. As tension is applied on the respective suture loops 126, 128, the anchors 122, 124 collapse and may form anchoring masses relative to selected portions of a subject, similar to the anchors 54, 56 discussed above. It is understood that the respective suture anchors 122, 124 may be collapsed simultaneously and/or at staggered times, as selected and/or desired by a user.

The suture loops 126, 128 are portions of a suture 130 that further include suture ends 132 and 134. The suture ends may be gasped or manipulated by a user to collapse the tubes 122, 124 to form the soft anchors. Additionally, the suture 130 may be passed through a passage portion 140 having a through-passage as discussed above and as disclosed in U.S. Pat. No. 8,118,836., incorporated herein by reference. The suture ends 132, 134 may be manipulated to move the passage portion 140 relative to the tubes 122, 124. As discussed above, the movement of the passage portion 140 relative to the tubes 122, 124 may tension the construct 100 relative to the tubes 122, 124 when the tubes are collapsed against a respective positive surface, such as a bone surface. Accordingly, the construct 100 may be tensioned relative to a bone surface as discussed further herein by pulling on the ends 132, 134 of the suture loop 130.

With reference to FIG. 3, a construct 170, according to various embodiments, is illustrated. The construct 170 may include various dimensions, such as a length 172 that may be about 3 cm to about 10 cm, including about 4 cm to about 8 cm. The construct 170 may further include a height 174 that includes a selected height of about 1 cm to about 4 cm, including about 2-3 cm. The height 174 may include a height or a length of arm portions 176 and 178 that extend from a main body portion 180 of the construct 170. The main body portion 180, however, may include an end 182 that may include a height 184 having a dimension of about 0.5 cm to about 2 cm, and further including a height of about 1 cm.

The construct 170 may be similar in construction to the constructs 20 and 100, as discussed above. Accordingly, the construct 170 can include any selected portion to interconnect with a suture and/or anchor assembly. For example, an eyelet can be formed near the terminal ends of the construct and/or throughbores may be formed through the construct 170. For example, a suture construct 52 a that includes an anchor 56 a can be coupled to an eyelet formed by folding over a terminal end and fixing it with a fixing structure 183 near the first end 182. The suture construct can be similar or identical to the suture construct 52. It is understood that each arm 176, 178 can include a fold formed eyelet and one or more throughbores and individual coupled suture constructs, according to various embodiments.

The construct 170, however, may include the single end 182 and the two arms 176 and 178 extending from an area at the second end of the construct 170. As discussed herein, the first end 182 may engage a first bone member or portion while the two arms 176 and 178 may engage separate bone members or constructs as discussed herein. Thus, at each arm 176, 178 and the first end 182 a suture construct including an anchor portion can be connected. Fixation of the construct 172 to selected bone portions may include various suture anchors and assemblies 50, 52 and 120 as discussed above. Accordingly, the construct 170 may be fixed relative to a selected portion of a subject similar to the fixation or anchoring mechanisms as discussed above.

With reference to FIGS. 1A-1B, discussed above, and additional reference to FIG. 4, the construct 20, or construct according to various embodiments as discussed above, may be engaged or associated with an anchor assembly 190. The anchor assembly 190 may include a fixation member 192, such as a Toggleloc™ anchor, sold by Biomet, Inc., that is rigid. The rigid fixation member 192 may include that illustrated and disclosed in U.S. Patent Application Publication No. 2012/0116452 and U.S. Pat. No. 7,695,503, both incorporated herein by reference. In addition, the anchor 192 may be interconnected or associated with a suture assembly 202, similar to the suture assemblies 50, 52 discussed above. The suture assembly 202 may include a passage portion 204 to which a continuous suture 206 is passed. The continuous suture 206 may include a continuous loop of suture that passes through the passage portion 204. The passage portion 204 may be formed through the anchor 192, as illustrated in FIG. 4.

The construct 20 may also be formed around the filament or loop portions of the suture portion 208 to engage the construct 20 relative to the anchor 192. The construct 20 may have the eyelet 42 formed by suturing or interconnecting an end 30 of the construct 20 with a suture portion 34. The construct 20, therefore, may be held relative to the anchor 192 with the suture assembly 202. Generally, the anchor 192 may include an elongated arm portion 220 and an eyelet or interconnection portion 222 to engage the suture assembly 202.

Accordingly, it is understood that the construct, according to various embodiments including the construct 20, the construct 100, and the construct 170, may be interconnected with a selected anchor or connecting portion. The connecting portion may include soft anchors, such as those illustrated with the suture assembly 50 or the suture anchor assembly 120. Additionally, a hard or rigid fixation member may include the fixation member 192 illustrated in FIG. 4.

The ligament construct, according to various embodiments as discussed above, may be provided relative to a selected portion of a subject, such as a foot 300 of a subject, illustrated in FIG. 5. The foot 300 of the subject may include various anatomical bone portions, such as those generally known in the art. For example, the foot 300 may include phalange members 302, metatarsal members 304, a medial (first tarsal) cuneiform 306, a navicular 308, a talus 310, and a calcaneus 312. The foot 300 may be connected or articulated with other boney portions, such as a tibia and a fibula, as is generally understood in the art.

With additional reference to FIG. 5, the various boney portions of the foot 300 may be interconnected with a construct, including the various embodiments of a construct as discussed above. For exemplary purposes, the construct 20 is illustrated and discussed. It is understood, however, that the construct 100 may be used relative to the foot 300 including the suture assembly 50, 52 and/or the anchor suture assembly 120, as discussed above. Nevertheless, for illustration of a selected procedure to replace a spring ligament or augment a spring ligament in a foot 300, the construct 20 is discussed further herein.

As illustrated in FIG. 5, the navicular 308 may be configured to include a throughbore 320 through which the anchor 54 may be passed and collapsed upon an exterior bone surface of the navicular 308 to form the anchoring mass or portion 54′, such as a soft anchor, relative to the navicular bone 308. The anchor portion 54′ may be defined as a large or anchoring mass formed near the bone surface. A locking profile of the tube 54 may allow the anchoring mass to be formed by the application of a tensile force with the suture 58. The bore 320 may be formed to allow for passage and receipt of at least a portion of the construct 20 into a portion of the bore 320. The drawing or tensioning of the construct 20 into the bore 320 may be performed with the suture assembly 52 by drawing or tensioning the suture ends 76, 78 and drawing the construct 20 into the bore 320. The formation of the bore 320 and tensioning of the construct 20 into the bore 320 will be discussed further in relation to the calcaneus 312 in a bore 340 formed therein, discussed further herein.

With a continuing reference to FIG. 5, the calcaneus 312 may have a bore 340 formed therein including a plurality of diameters. For example, a first or small drill/pin 342 may be passed through or drilled through the calcaneus 312 to form a small bore or first bore passage 344. A second or larger drill bit 349 (the larger drill bit 349 may be cannulated) may be passed over the small bit 342 to form a second or larger bore 352. Accordingly, the bore 340 formed through the calcaneus 312 may include a first diameter bore 344 and a second diameter bore 352. The bore 320 formed in the navicular 308 may include a similar large diameter bore portion and a small diameter bore portion. The large diameter bore portion may receive a portion of the construct 20 while the small diameter bore portion may allow for passage of the suture construct 50, 52 to allow for movement of the respective tubes 54, 56 to a second portion of the respective bone to form the soft anchor relative thereto. Moreover, a shoulder or ledge 320 a, 340 a is formed within the respective bores 320, 340 due to the different diameters.

With reference to FIG. 6, the anchor assembly, including the suture anchor assembly 52 that is connected to an end of the construct 20, may be passed through the bore 340 formed to the calcaneus 312, or selected bone portion. The suture assembly 52 and/or only the anchor 56 alone may be passed through the bore 340. An appropriate passing member may interconnect with the anchor 56 and/or the suture ends 80, 82 to push or pull the suture assembly through the bore 340 formed to the calcaneus 312. The construct 20 interconnected with the suture anchor assembly 52, however, may be moved relative to the calcaneus 312 to allow for passage of the suture anchor assembly 52 through the bore 340 formed through the calcaneus 312.

As illustrated in FIG. 6, the construct 20 may be pulled into the bore 320 formed in the navicular 308 and the anchoring portion 54′ may be formed relative to the navicular 308 by tensioning the anchor 54 relative to the navicular 308, as is generally understood in the art. The suture assembly 52 may then be moved through the bore 340 formed through the calcaneus 312, as illustrated in FIG. 6. It is understood, however, that the suture assembly 52 may be first passed through the calcaneus 312 prior to passage of the suture assembly 50 through the navicular 308. The order of placing the anchors relative to individual bone portions is exemplary, and not intended to be limiting. After forming the bore 340 through the calcaneus 312, the suture assembly 52 may be passed through the calcaneus 312. According to various embodiments, the anchors, including the soft anchors, can be formed on the surface of the bone portions at all selected anchoring points. Then each end of the construct can be alternatingly tightened to substantially ensure uniform tensioning of the construct 20.

The passage of the suture assembly 52 through the calcaneus 312 may generally be in the direction of arrow 313. The passage of the suture assembly 52 may be according to appropriate mechanisms, such as pulling the suture assembly 52 through the bore 340 or pushing the suture assembly 52 through the bore 340. Generally, however, the anchor 56 may be passed through a distal cortical bone portion 391 a, as illustrated in FIG. 7A, and a second cortical bone portion 391 b, is also illustrated in FIG. 7A. The bore 340 may further be formed through both of the cortical bone portions 391 a and 391 b and further through the cancellous bone portion 389, therebetween.

Accordingly, a soft anchor may be formed by the anchor 56 on an exterior distal surface of the cortical bone portion of the calcaneus 312. The anchor 56 may be formed by drawing the construct 20 into the large bore portion 352, by manipulating the ends of the suture filaments 80, 82, to form the soft anchor 56′. The construct 20 may then be tensioned and drawn into the bore 340.

With continuing reference FIGS. 5 and 6, and additional reference to FIGS. 7A and 7B, the construct 20 may be tensioned into the bore 320 formed within the navicular 308 and the bore 340 formed in the calcaneus 312. The bore 320 in the navicular 308 may include a large bore portion 320 a and a small bore portion 320 b similar to the large bore 352 and the small bore portion 344 formed through the calcaneus 312. The large bore portion, of both the navicular 308 and the calcaneus 312, may include a diameter 352 a such as about 4 mm to about 6 mm. The small bore portion of both the calcaneus 312 and the navicular 308 may include a diameter 344 a of about 2 mm to about 4 mm. It is understood, however, that the bore formed through the respective bone portions may be any appropriate diameter to receive the constructs positioned within the respective bore portions and interact with the anchor members positioned relative to the bone portions.

The anchor portion 54′ formed by the tube 54 and anchor portion 56′ formed by the tube 56 may be formed on an exterior surface of the bone portions 308, 312 such as on an exterior surface of the cortical bone thereof. The anchor portions 54′, 56′ can fix or anchor the construct 20 relative to the bone portions. The anchor portions 54′, 56′ may be defined as a large or anchoring mass formed near the bone surface. A locking profile of the tubes 54, 56 may allow the anchoring mass to be formed by the application of a tensile force with the suture 58, 60. The construct 20 may then be tensioned relative to the anchor portions 54′, 56′ to form a selectively tensioned construct 20 relative to the two bones of the navicular 308 and the calcaneus 312 to augment or replace the spring ligament.

The soft anchors 54′, 56′ however, may be formed within the respective bone portions 308 and 312 relative to a cancellous bone portions 389 and 367 to engage the proximal cortical bone portions 391 b and 369 of the respective bone members 308 and 312. Accordingly, the soft anchor portions 54′, 56′ need not be formed on the exterior surface of the respective bone member 308 and 312 to anchor the construct 20 relative to the respective bone portions 308 and 312. Rather, the bone anchors or construct anchors may be formed within the bone surfaces to provide for fixation of the construct 20 relative to the respective bone members 308 and 312. Formation of an anchor assembly within the bone member may be formed as discussed above and with an anchor assembly as disclosed in U.S. Patent Application 2011/0098727, published Apr. 28, 2011, incorporated herein by reference. The formation of the soft anchor 54′, 56′ may be substantially similar, save that the soft anchor is formed within the tunnel 340 and 320 of the respective bone members.

The construct 20 may be positioned relative to respective bone portions, such as the calcaneus 312 and navicular 308, as discussed above and illustrated in various figures, including FIGS. 6-7B. The construct 100 may be similarly positioned between two selected bone portions, such as the calcaneus 312 and navicular 308. According to various embodiments, the construct 170 may be interconnected with two or more bones portions of the foot 300, as illustrated in FIG. 8. The construct 170, including the main body portion 180, the arm member 178, and the arm member 176 may be connected or positioned relative to the navicular 308 and the first cuneiform 306. Additionally, the end of 182 of the main body 180 may be positioned relative to the calcaneus 312 of the foot 300.

The fixation of the construct 170 relative to the respective bone portions may be with the suture anchor construct, such as the suture anchor construct 52. Accordingly, each of the ends of the construct 170 may be coupled to bone portions with a suture anchor such as the suture anchor at 56 a relative to the first cuneiform, a suture anchor 56 b relative to the navicular 308, and a suture anchor 56 c relative to the calcaneus 312. It is understood, however, that the various anchor of fixation members may be positioned relative to the respective boney members, including the first cuneiform 306, navicular 308, and the calcaneus 312, to fix the construct 170 relative thereto. For example, the suture anchor assembly 120 may be interconnected with the construct 170 to anchor relative to the selected bone portions in addition to the anchor fixation member 190, as illustrated in FIG. 4.

Accordingly, a ligament construct may be provided to augment and/or replace the spring ligament. The ligament construct, therefore, can interconnect various portions of the foot 300, including the calcaneus 312 and the navicular 308. In various embodiments, the first cuneiform 306 may also be interconnected relative to the navicular 308 and the calcaneus 312. The interconnection of the respective boney portions of the foot 300 may be provided to augment or replace the spring ligament of the foot 300. The spring ligament to the foot 300 may be further augmented by interconnecting the respective construct, such as the construct 20 or the construct 170, with the spring ligament. The interconnection of the construct relative to the spring ligament may be provided by further suturing the construct to the spring ligament. For example, the construct may be sutured directly to the spring ligament by generally known suture techniques such as threading or knotting the appropriate construct to a portion of the spring ligament that is remaining in the foot 300. For example, the spring ligament may be interconnected by the navicular bone 308 portion and the augment may be sutured to the spring ligament that remains connected at the bone portion. Accordingly, it is understood that the construct, as discussed above, may be provided to replace or augment the spring ligament in the foot 300. Moreover, the construct may be interconnected with a respective bone portion of the foot 300, according to various embodiments, including those discussed above. The construct, such as the construct 20, the construct 100, or the construct 170 may be formed through various weaving and molding techniques to provide an appropriate construct to replace or augment the spring ligament in the foot 300.

With reference to FIGS. 9 and 10, a deltoid ligament in the foot 300 can interconnect a tibia 321 relative to the foot 300. The deltoid ligament can interconnect the tibia 320 relative to the calcaneus 312, the navicular 308, and a talus 322. The tibia 321, the talus 322, the navicular 308 and the calcaneus 312 can be interconnected with a construct 350, as illustrated in FIG. 9. The ligament construct 350 can include construct bodies 350 a and 350 b that are formed similar to the ligament construct 20, as discussed above. Accordingly, the construct bodies 350 a and 350 b can be formed as substantially elongated members extending between first and second respective ends and can be formed of a woven polymer material and/or a solid material.

According to various embodiments, the first construct body 350 a can extend from a first end 360 that has a first eyelet formed by folding over and fixing (e.g. via suturing or sonically welding) with a fixing member or system 362 a terminal end of the main body to an internal position of the body 350 a. Positioned through the eyelet at the first end 360 can be a first suture construct 364. The first suture construct 364 can be similar to the suture construct 50 discussed above, and will not be described here in detail. Nevertheless, the suture construct 364 can include a collapsible tube 366 that is formed around a suture 368 that passes through a passage portion 370 with first and second suture ends 372 and 374 extending therefrom. As discussed above, the suture construct 364 can be positioned relative to a bone portion, as discussed further herein, to allow the collapsible tube 366 to form an anchoring mass by drawing or pulling on the suture end 372 and 374.

The first construct body 350 a may extend from the first end 360 to a second end 380 that also has an eyelet that may be formed by fixing a terminal end at the second end 380 with a fixation portion 382. A second suture construct 390 can also be passed through the eyelet that includes a collapsible tube 394 formed around a suture 396. The suture 396 can have a passage portion 398 through which the suture passes and a first end 400 and a second end 402 extends therefrom. Again, the suture construct 390 can be used to tension and anchor the first body 350 a relative to selected boney portions, as discussed further herein.

Additionally, passed or formed through the eyelet at the second end 380 can be the second construct body 350 b. The second construct body 350 b can extend from a first end 420 that forms an eyelet by having a terminal end portion fixed a distance from the terminal end with a fixation mechanism 422. Passed through the eyelet formed at the first end 420 can be a third suture construct 430, similar to the suture constructs 364 and 390. Accordingly, the suture construct 430 can include a collapsible tube 432 that is formed around a suture 434 that passes through a passage body or portion 436 with a first terminal end 438 and a second terminal end 440 extending therefrom. Again, the suture construct 430 can be used to fix or anchor the second body portion 350 b by forming the collapsible tube 432 into an anchor mass by pulling on the terminal suture ends 438 and 440.

The second construct body 350 b may extend from the first end 420 to a second end 450 that may also include a second eyelet formed by fixing a terminal end a distance from the terminal end with a fixation portion 452. A fourth suture construct 460 can also be passed through the eyelet formed at the second end 450. The fourth suture construct 460 can include a collapsible tube 462 that is formed over a suture 464. The suture 464 can include a passage portion 466 from which extends a first terminal suture end 468 and a second terminal suture end 470. Therefore, the fourth suture construct 460 can also be used to form an anchoring mass by drawing the terminal suture ends 468 and 470 as discussed above.

The augment or replacement construct 350 can be used to interconnect at least a tibia 321, talus 322, navicular 308, and calcaneus 312 by positioning the respective suture constructs, 390, 430, 460, and 364 in bone tunnels formed in the respective bone portions. Without repeating the procedure discussed above for forming the bone tunnels, bone tunnels can be formed in and/or through each of the bone portions similar to a manner as discussed above. Accordingly, a first tunnel 500 can be formed in the tibia 321 and the collapsible tube 394 can be formed into the anchoring mass 394′ on an exterior surface of the tibia 321. A portion of the construct 350 can then be tensioned or drawn into the tunnel 500, as discussed above. A second tunnel 520 can be formed through the talus 322 and the collapsible tube 432 can be formed into the anchoring mass 432′ on an exterior surface of the talus 322. A portion of the construct 350 can be tensioned into the tunnel 520, as discussed above. A third tunnel 530 can be formed in the calcaneus 312 and an anchor mass 366′ can be formed from the collapsible tube 366 and the construct can be tensioned into or onto the calcaneus 312, as discussed above.

A fourth tunnel 540 can be formed into the interior talus or, alternatively, into the navicular 308 (shown in phantom at 540′). It is understood, however, that if the alternative tunnel 540′ is formed in the navicular 308 the tunnel 540 may also be formed in an anterior portion of the talus 322 to allow connection of the navicular 308 and the talus 322. The suture construct can be similar to the anchor 120, illustrated in FIG. 2B, to allow for interconnection with a tunnel formed in the anterior portion of the talus 322. Accordingly, it is understood that the construct 350 can be provided to interconnect a plurality of bone portions of the foot 300 including interconnection with a leg bone portion, such as the tibia 321. Moreover, it is understood that the suture constructs can be provided in various configurations to allow for fixing of the ligament or tendon construct 350 to the respective bone portions.

It is understood that the various embodiments of the ligament constructs including the eyelets discussed above can be formed in substantially similar manner and interchanged for various purposes. Moreover, a selected eyelet can be formed in an appropriate manner for selected procedures, as is understood by one skilled in the art. Moreover, forming the eyelets in various manners can be used for productions, efficiencies and/or costs and specific procedures.

The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and may be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such modifications are intended to be included within the scope of the disclosure. The terminology used herein is for the purpose of describing particular example embodiments only and is not intended to be limiting. As used herein, the singular forms “a,” “an,” and “the” may be intended to include the plural forms as well, unless the context clearly indicates otherwise. 

What is claimed is:
 1. A method of augmenting a ligament, comprising: forming a first bore in a first bone; forming a second bore in a second bone, wherein the second bone is separate from the first bone and naturally connected with a natural ligament; positioning a first anchoring mass relative to the first bone via the first bore; positioning a second anchoring mass relative to the second bone via the second bore; and tensioning a ligament construct between the first anchoring mass and the second anchoring mass anchor.
 2. The method of claim 1, wherein forming the first bore in the first bone includes forming the first bore in a navicular bone; wherein forming the second bore in the second bone includes forming the second bore in a calcaneus bone.
 3. The method of claim 1, wherein positioning the first anchoring mass relative to the first bone via the first bore includes passing a first anchor through the first bone and positioning the first anchor on an exterior surface of the first bone opposite an insertion position of the ligament construct.
 4. The method of claim 3, further comprising: applying a tensile load to the first anchor after passing the first anchor through the first bore, including applying the tensile load to a portion of a suture construct to form the first anchoring mass with the first anchor having a locking profile engaging the exterior surface of the first bone, wherein applying the tensile load collapses the first anchor from a first profile to a second profile having a larger diameter to form the anchoring mass.
 5. The method of claim 1, wherein positioning the first anchoring mass relative to the first bone via the first bore includes passing a first anchor into the first bore and into the first bone and positioning the first anchor on an exterior surface of the first bone away from an insertion position of the ligament construct.
 6. The method of claim 5, further comprising: applying a tensile load to the first anchor after passing the first anchor into the first bore, including applying the tensile load to a portion of a suture construct to form the first anchoring mass with the first anchor having a locking profile engaging the interior of the first bone, wherein applying the tensile load collapses the first anchor from a first profile to a second profile having a larger diameter to form the first anchoring mass.
 7. The method of claim 1, wherein tensioning the ligament construct includes applying tension to a first and a second end of a suture portion; wherein the suture portion is interconnected with the ligament construct and at least one of a first anchor and a second anchor; wherein the suture portion has a passage portion that defines a through-passage and the suture portion is a continuous loop, wherein the first end is passed through a first aperture defined by the suture into the through-passage of the passage portion defined by the suture and out a second aperture defined by the suture so as to place the first end outside of the passage portion and form a first suture loop and the second end of the suture is passed through a third aperture into the through-passage of the passage portion and out a fourth aperture so as to place the second end outside of the passage portion to form a second suture loop.
 8. The method of claim 1, wherein forming the first bore in the first bone and forming the second bore in the second bone includes, separately: drilling a first through bore through a proximal cortical bone layer and a distal cortical bone layer with a first diameter drill; over drilling a second bore through the proximal cortical bone layer and short of the distal cortical bone layer; wherein each of the first bore and the second bore define an internal shoulder.
 9. The method of claim 1, further comprising: connecting the ligament construct with at least a portion of the ligament configured to interconnect the first bone and the second bone.
 10. The method of claim 1, further comprising: positioning a third anchoring relative to a third bone; and tensioning the ligament construct relative to each of the first bone, the second bone, and the third bone; wherein all of the first bone, the second bone, and the third bone are within a foot.
 11. The method of claim 1, further comprising: positioning a fourth anchoring relative to the third bone or a fourth bone; and tensioning the ligament construct relative to each of the first bone, the second bone, the third bone, and the fourth bone; wherein all of the first bone, the second bone, the third bone, and the fourth bone are within a foot or articulate with the foot; wherein positioning the fourth anchoring may be in the third bone.
 12. The method of claim 1, forming the first bore in the first bone and forming the second bore in the second bone includes, separately: forming each of the first bore and the second bore to define an internal shoulder.
 12. A method of augmenting a ligament, comprising: forming a first bore in a tibia bone; forming a second bore in a calcaneus bone, wherein the calcaneus bone is separate from the tibia bone; providing a ligament construct connected to a first suture construct and a second suture construct, each of the first suture and the second suture having a passage portion that defines a through-passage and at least one suture loop relative to the passage portion and a first end and a second end; providing a first collapsible soft anchor connected to the first suture construct; providing a second collapsible soft anchor connected to second suture construct; positioning the first collapsible soft anchor tube relative to the tibia bone via the first bore; positioning a second collapsible soft anchor relative to the calcaneus bone via the second bore; applying a first force to the first collapsible soft anchor with the first suture construct to form a first anchoring mass with the first collapsible soft anchor; applying a second force to the second collapsible soft anchor with the second suture construct to form a second anchoring mass with the second collapsible soft anchor; and tensioning the ligament construct between the first anchoring mass and the second anchoring mass.
 13. The method of claim 12, wherein positioning the first collapsible soft anchor relative to the tibia bone via the first bore and positioning the second collapsible soft anchor relative to the calcaneus bone via the second bore includes passing the respective first collapsible soft anchor and the second collapsible soft anchor through the respective first bore and second bore to place the first collapsible soft anchor on an exterior surface of the tibia and to place the second collapsible soft anchor on an exterior surface of the calcaneus.
 14. The method of claim 12, wherein tensioning the ligament includes applying a force to the first end and the second end of the first suture construct after the first anchoring mass is formed to at least draw the ligament construct towards the tibia bone.
 15. The method of claim 12, wherein tensioning the ligament includes applying a force to the first end and the second end of the second suture construct after the second anchoring mass is formed to at least draw the ligament construct towards the calcaneus bone.
 16. The method of claim 12, wherein providing a ligament construct connected to a first suture construct and a second suture construct includes providing an elongated construct having a first terminal end folded and attached centrally of the first terminal end to form a first eyelet through which the first suture construct is positioned and a second terminal end folded and attached centrally of the second terminal end to form a second eyelet through which the second suture construct is positioned.
 17. The method of claim 16, further comprising: providing the ligament construct formed of a woven polymer material.
 18. The method of claim 12, wherein providing a ligament construct connected to a first suture construct and a second suture construct includes providing an elongated construct having a first bore formed through a first end through which the first suture construct is positioned and a second bore formed through a second end through which the second suture construct is positioned.
 19. The method of claim 12, further comprising: forming a third bore in a calcaneous; forming a fourth bore in the calcaneous; positioning a third collapsible soft anchor relative to the calcaneousbone via the third bore; and positioning a fourth collapsible soft anchor relative to the calcaneousbone via the fourth bore.
 20. A method of augmenting a ligament, comprising: forming a ligament construct extending from a first terminal end to a second terminal end; forming a first passage near the first terminal end of the ligament construct; forming a second passage near the second terminal end of the ligament construct; connecting a first suture construct to the ligament construct through the first passage; connecting a second suture construct to the ligament construct through the second passage; providing each of the first suture construct and the second suture construct having a passage portion that defines a through-passage, where a first end of each suture is passed into the through-passage through a first aperture to form a first loop and exits the through-passage through a second aperture and a second end of each suture is passed into the through-passage through a third aperture to form a second loop and exits the through-passage through a fourth aperture; and coupling a first soft anchor to the first suture construct and a second soft anchor to the second suture construct.
 21. The method of claim 20, wherein forming the first passage near the first terminal end of the ligament construct includes folding the first terminal end inwards to a first position towards a center of the ligament construct and fixing the first terminal end at the first position; and wherein forming the second passage near the second terminal end of the ligament construct includes folding the second terminal end inwards to a second position towards the center of the ligament construct and fixing the second terminal end at the second position.
 22. The method of claim 20, wherein forming the first passage near the first terminal end of the ligament construct and forming the second passage near the second terminal end of the ligament construct includes forming a throughbore through the ligament construct from a first side to a second side.
 23. The method of claim 20, where coupling the first soft anchor to the first suture construct includes coupling a first collapsible tube about the first suture construct and the second soft anchor to the second suture construct includes coupling a second collapsible tube about the second suture construct.
 24. The method of claim 23, further comprising: providing the first collapsible tube to collapse and the second collapsible tube to collapse when a tensile force is applied by the respective first suture or second suture.
 25. The method of claim 20, wherein forming the ligament construct extending from the first terminal end to the second terminal end includes forming a first arm and a second arm to extend near the second end transverse to a longitudinal axis of the ligament construct defined between the first terminal end to the second terminal end.
 26. An augmenting ligament, comprising: a ligament construct extending from a first terminal end to a second terminal end having a first passage near the first terminal end of the ligament construct and a second passage near the second terminal end of the ligament construct; a first suture construct coupled to the ligament construct through the first passage; a second suture construct coupled to the ligament construct through the second passage; a first soft anchor coupled to the first suture construct; and a second soft anchor coupled to the second suture construct; wherein each of the first suture construct and the second suture construct has a passage portion that defines a through-passage, where a first end of each suture construct is passed into the through-passage through a first aperture to form a first loop and exits the through-passage through a second aperture and a second end of each suture construct is passed into the through-passage through a third aperture to form a second loop and exits the through-passage through a fourth aperture.
 27. The augmenting ligament of claim 26, wherein the first passage near the first terminal end of the ligament construct is defined by the first terminal end folded inwards to a first position towards a center of the ligament construct and fixed at the first position; and wherein the second passage near the second terminal end of the ligament construct is defined by the second terminal end folded inwards to a second position towards the center of the ligament construct and fixed at the second position.
 28. The augmenting ligament of claim 26, wherein the first passage near the first terminal end of the ligament construct and the second passage near the second terminal end of the ligament construct are defined by a throughbore through the ligament construct from a first side to a second side.
 29. The augmenting ligament of claim 26, where the first soft anchor is a first collapsible tube configured to form a first anchoring mass coupled about the first suture construct and the second soft anchor is a second collapsible tube configured to form a second anchoring mass coupled about the second suture construct.
 30. The augmenting ligament of claim 26, wherein the ligament construct includes a first arm and a second arm extending near the second end transverse to a longitudinal axis of the ligament construct defined between the first terminal end to the second terminal end.
 31. The augmenting ligament of claim 26, wherein the ligament construct includes a first ligament construct and a second ligament construct; wherein the first ligament construct is passed through the first passage to form a cruciform configuration. 